SuO034ARE THERE COMMON PREDISPOSING FACTORS WHICH INCREASE THE RISK OF DEVELOPING AKI IN THE COMMUNITY?

Abstract

Introduction and Aims: The awareness of the importance of acute kidney injury and the impact it has on mortality and the progression to Chronic Kidney Disease (CKD) has been highlighted a number of studies in recent years. A report in the UK by the National Confidential Enquiry into Patient Outcome and Death in 2009 found that 30% of AKI in hospitals was avoidable. These studies show that people who develop AKI have significantly increased risk of both short-term and long term mortality compared to those who do not, in addition patients who survive have an increased risk of progressive CKD. A number small of inpatient studies that have shown that the incidence of community acquired AKI (CA-AKI) is three times greater than hospital acquired (HA-AKI). However, much of the data does not include patients with CA-AKI who are managed entirely in the community and there remains no true consensus of whether there are any common predisposing factors which increase the individual risk of developing AKI in the community. The purpose of this study was to examine factors that increased the risk of developing AKI in the community and to describe the differences between those patients with CA-AKI who are admitted to hospital with those who are not. Methods: The study cohort was identified by combining data from two existing datasets described elsewhere The Study period was 01/02/2009 - 31/07/2009. Inclusion criteria: People who had a serum creatinine request during the study period, were aged 18 or over and were not already on renal replacement therapy. Patients were excluded if they did not have a baseline serumcreatinine within the previous 12months and those who were admitted to hospital and subsequently developed AKI during the admission. The data was analysed using descriptive statistics and binary logression analysis. Ethical approval was granted by the National Research Ethics Service Committee. Results: A total of 77,811 from a population of 532,800 adults in region fulfilled the inclusion criteria. The mean age was 64 yrs and 45% were male. The prevalence of diabetes, hypertension and Chronic Kidney disease CKD stages 3-5 were 28%, 12% and 21% respectively. Survival analysis shows a 69% (AKI 1) 49% (AKI 2) 45% (AKI 3) over a 2 year period of follow up compared to a 91% in those with no AKI. The risk of death at 30 days was 3.2 (AKI 1), 9.8 (AKI 2), 11.0 (AKI 3) times more likely to die than those with 'NO AKI' having controlled for age, gender, stage eGFR, admission status and Charlson co-morbidity score. Further analysis of co-morbidity show a number of co-morbidities increase the risk of developing AKI including Stage CKD, liver disease, heart failure hypertension diabetes dementia and malignancy. Conclusions: This study shows that people developing AKI in the community have a significantly increased risk of death than those who do not. The development of AKI can be associated with age, CKD and co-morbidity. However our model only explained 20% of the variance shown and demonstrates the need for further investigation around individual circumstances that prompt the request for a serum creatinine in the community particularly when the result demonstrates AKI and a decision is made not to admit the patient to hospital. (Figure Presented).